Privacy Policy

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACFESS TO THIS INFORMAITON. PLEASE REVIEW IT CAREFULLY.

This notice of Privacy Practices describes how we may use and disclose your protected health/personal information (PHI) to carryout out treatment, payment or business operations (TPO) and for other purposes that are permitted or required by law.It also describes our rights to access and control you protected information.“Protected health/personal information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.

1. Uses and Disclosures of Protected Health/Personal Information

Your protected health/personal information may be used and disclosed by our medical director, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you to support business operations of this office, if requested by you to a finance company to pay for your care, and any other use required by law.

Treatment: We will use and disclose your protected health/personal information to provide, coordinate, or manage you health care and any related services.This includes the coordination or management of your health care with a third party.For example, we would disclose your (PHI) as necessary, if, as a result of our service, you require treatment by a physician.You (PHI) may be provided to a physician to who you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

PAYMENT:Your (PHI) will be used, if requested, to obtain payment for your services.For example, if you desire to finance the costs of your treatments, this may involve disclosing relevant protected private information in order to obtain approval.

HEALTHCARE OPERATIONS:We may use or disclose as needed, your (PHI) in order to support the business activities of this office. These activities include, but are not limited to, quality assessment activities, employee review activities, licensing, and conducting or arranging for other business activities.In addition, we may use a sign=in sheet at the registration desk where you may be asked to sign your name. We may also call you by name in the waiting room when we are ready to see you.We may use or disclose you (PHI) as necessary, to contact you to remind you of your appointment.

We may use or disclose your (PHI) in the following situations without your authorization.These situations include: as required by law; public health issues as required by law, communicable diseases: health oversight; abuse or neglect; Food and Drug Administration requirements; legal proceedings; law enforcement; coroners, funeral directors and organ donating; research; criminal activity and national security; workers compensation; inmates; required uses and disclosures.Under the law, we must make disclosure to you and, when required by the Secretary of the Department of Health and Human Services, to investigate or determine our compliance with the requirements of Section 164.500

OTHER PERMITTED AND REQUIRED USES AND DISCLOSURES will be made only with your consent, authorization or opportunity to object unless required by law.

You may revoke this authorization, at any time, in writing, except to the extent that this office has taken an action in reliance on the use or disclosure indicated in the authorization.

PATIENT CONSENT FOR USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION (PHI)

I hereby give my consent for The Office of Dr.Franziska Huettner, to use and disclose Protected Health Information (PHI) about me to carry out Treatment, Payment, and Healthcare Operations (TPO). (The offices of Dr.Franziska Huettner, Notice of Privacy Practices provide a more complete description of such use and disclosures.)

I have the right to review the Notice of Privacy Practices prior to signing this consent. The Office of Dr.Franziska Huettner, reserve the right to revise its Notice of Privacy Practices at anytime. A revised Notice of Privacy Practices may be obtained by forwarding a written request to The Office of Dr.Franziska Huettner, at 568 Park Avenue, N.Y., N.Y. 10065

With this consent, The Office of Dr.Franziska Huettner, may call my home or other alternative location and leave a message on voicemail or in person in reference to any items that assist the practice in carrying out TPO, such as appointment reminders, insurance items and any calls pertaining to my clinical care.

With this consent, The Office of Dr.Franziska Huettner, may mail to my home or other alternative location any items that assist the practice in carrying out the TPO, such as appointment reminder cards and patient statements as long as they are marked Personal and Confidential.

With this consent, The Office of Dr.Franziska Huettner, may email to my home or other alternative location any items that assist the practice in carrying out the TPO, such as appointment reminder cards and patient statements. I have the right to request that The Office of Dr.Franziska Huettner, restrict how it uses or discloses my PHI to carry out TPO. However, the practice is not required to agree to my requested restrictions, but if it does, it is bound by this agreement.

By signing this form, I am consenting The Office of Dr.Franziska Huettner, use and disclosure of my PHI to carry out TPO. I may revoke my consent in writing except to the extent that the practice has already made disclosures in reliance upon my prior consent. If I do not sign this consent, or later revoke it; The Office of Dr.Franziska Huettner, may decline to provide treatment to me.